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Leveraging Business Acumen to
Help Clinicians Get IT!
Session 12, February 12, 2019
Becky Fox, MSN, RN-BC, Chief Nursing Informatics Officer
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Becky Guess Fox, MSN, RN-BC
Has no real or apparent conflicts of interest to report.
Conflict of Interest
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• Overview of the IV and PCA Pump Project
• Our Organizational Procurement Process
• Opportunities Identified to Build “Relationship Bridges”
• Understanding Clinical Body of Knowledge
• Recognizing Need for Knowledge and Clinical Involvement
Agenda
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• Building the operational, clinical business case
– Laying the Foundation
– Painting the Whole Picture with Valid Data
– “Powering Up” and Achieving Organization Consensus
– Determining ROI
– Strategic Messaging to Build Consensus and Support for the
Project
– Value Proposition
• Facilitating Organizational Understanding of Health IT Value
• Identifying Barrier and Risks
• Lessons Learned and Key Take Aways from Our Organization
• Questions and Answers
Agenda (continued)
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• Apply methods learned through project examples provided to collaboratively engage
clinicians in establishing channels for communication and education that strengthens
financial and business acumen
• Identify activities that clinicians and informaticists can employ to ensure assigned
projects are designed to be measured according to the metrics and key outcomes
that the healthcare enterprise is looking to achieve
• Develop channels to identify opportunities for volunteering or shadowing senior
executives beyond traditional manager/mentor engagements that
clinicians/informaticists may utilize to gain insights into how decision-making occurs
at executive levels using financial/business analysis
Learning Objectives
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IV/PCA Pump Project
• Replacement of IV and PCA pumps across 60+
patient care locations:
– 12 acute care facilities
– >25 ambulatory and infusion clinics
– Other settings such as free standing emergency
departments, outpatient surgery, mobile hospital,
School of Nursing, simulation center
• Replacement only
• Total of more than 6,000+ components of equipment
• IV and PCA pumps would be utilized by more than
8,500 nurses to administer more than 1M+ infusions
annually
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IV and PCA Pump Replacement
Historical Perspective
• Replacement of IV and PCA pumps were considered
separate projects
• Implementation was scheduled facility by facility,
implemented over multiple years
• Full technology benefit may not be achieved until
completion of rollout
• Due to competing priorities, replacement projects can
often be postponed
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• Established an interdisciplinary Steering Committee to provide
guidance, oversight and recommendations
– Assess current state (internal and vendor assessments)
– Determine infusion management plan/roadmap to meet
current and future needs
– Determine key functionality requirements
– Evaluate ROI analysis; determine outcome metrics
– Recommend vendor
– Submit request for purchase and achieve approval
– Implement & monitor metrics for success!
Our Organization’s Procurement Process
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Opportunities Identified to Build
“Relationship Bridges”
Business and IT
Understanding
• Technical and
Infrastructure
Requirements
• Implementation
Process
• Capital Process
Clinical
Understanding
• Clinical Workflow
Requirements
• Patient Safety
Impact
• Future Infusion
Roadmap
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• Financial modeling and is not (typically) a component of training
• Career progression emphasizes staff management and clinical
outcomes with limited business and IT systems training
• Business knowledge is not necessarily a regulatory requirement
• Need for greater understanding of interdependencies and
complexities of IT systems management
Understanding Clinical Body of
Knowledge
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• In 2006, the TIGER Initiative, a nursing grassroots community
recognized the need for improved preparation of clinical staff
using informatics to improve patient care
• In 2011, the TIGER Initiative published recommendations of
Informatics Competencies which included a focus on:
– Basic Computer Competencies
– Information Literacy
– Information Management
• ANA has recognized the importance of early involvement of
clinicians in technology projects (Weckman, Janzen, 2009).
“The best IT project is the one that is not an IT project” (Murphy,
2009).
Need for Additional Knowledge and
Clinical Involvement
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Building the operational,
clinical business case
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Laying the Foundation
• Leverage prior successful business cases
• Identify decision makers, key stakeholders and influencers
• Connect with other healthcare systems
• Understand industry direction
• Leverage vendor(s) success stories
• Considerations for outside influences, such as regulatory
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Painting the Whole
Picture with Valid Data
• Clinical (Pharmacy, Nursing)
• Financial (product waste, risk)
• Safety (drug library utilization, pharmacy build,
number of alerts and/or lack thereof)
• Outcomes (care events, teammate satisfaction)
• Workflow efficiencies (time and motion, LEAN,
Agile processes)
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• Established Steering Committee
– Minimum inclusion of at least1 stakeholder from key areas
impacted by project
– Included Nursing, Pharmacy, Information and Analytic
Services, Technology, Clinical Engineering, Materials
Management, Procurement
• Leveraged additional supporters through key groups such as
Clinical Informatics Coordinators, Physicians IT Leaders,
Informatics Councils, Nursing Practice Councils and other key
projects (e.g. Critical Care Leaders, Quality Leaders)
“Powering Up” and Achieving
Organizational Consensus
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• Supporting teammate knowledge of business, financial and
strategic acumen through mentoring, formal & informal education,
group learning experiences, case-study review
• Create opportunities to share the stories of success
• Create opportunities to share the thought process of prior
successful projects
• Create shadow experiences for key stakeholders, decision
makers
– Rounding
– Observations and discussions in/outside of organization
– Informal discussions
• Create opportunities for influencers of key stakeholders
“Powering Up” and Achieving
Organizational Consensus
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• Review historic, successful key metrics
• Consider cost savings, time/efficiencies, safety, outcomes, risk,
and impact to the experience of the consumer, patient, clinician
and teammate
• Understand ROI is different, for different stakeholders in the
organization
• Consider how each decision maker will view ROI:
– Will individual ROI be weighted?
– How will the project be prioritized?
• Contextualize the project into the greater system needs
• Consider how metrics will be evaluated throughout the project or
post-implementation
Determining ROI
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• Consider what information to present (formally and informally):
– Fact based
– Without emotional components
– Focus on each stakeholders view of value proposition
– Tie to system goals of the health system
• Consider different methods of communication:
– Types of learners
– Written considerations
– Pictures and infographics help communicate complex topics
Strategic Messaging to Build Consensus
and Support for the Project
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• A value proposition is a promise of value to be delivered,
communicated, and acknowledged.
• It is also a belief from the customer about how value will be
delivered, experienced and acquired.
• A value proposition can apply to an entire organization, or parts
thereof, or customer accounts, or products or services.
-Wikipedia
Value Proposition Definition
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• Clinicians - Improved drug library; improved workflow with one
system for both IV and PCA pumps; improved patient safety
• Pharmacy – Improved drug library management
• IT – Easier management of pump and drug library updates;
improved equipment management
• Security – HIPPA compliant, US based data management
• Operations – Improved patient safety
• Procurement – One vendor for IV and PCA pumps
• Finance / Leadership – Improved patient safety, decreased risk;
improved teammate experience; and decrease in cost of rental
equipment
Strategic Messaging and Value
Proposition Examples
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• Laying the foundation
• Painting the whole pictured with valid data
• ‘Powering up’ and achieving organizational consensus
• Determining ROI
• Strategic Messaging to Build Consensus and Support for the
Project Developing value propositions
• …and….
Facilitating the Organizational
Understanding of Health IT Value
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Make the (specific) Ask
• Ask for personal, department, organizational support
• Ask for approval of the project
• Ask for commitment to project success
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• “I’ve never” experiences
• Factual stories and examples are needed
• Misinterpretation of messaging
• Information not disseminated effectively
Identifying Barriers and Risks
“Obstacles do not block the path, they are the path.”
Anonymous
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• Create environment that develops business, financial and
strategic acumen with clinical staff (and vice versa)
• Create formal and informal shadowing & learning experiences
between clinical, business leaders and teammates for future
initiatives and projects
• Create opportunities to 'share' the stories of success as well as
the business, financial and strategic acumen which contributed to
the success
• Make the ask!
Lessons Learned and Key Take Aways
from Our Organization
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• AONE Position Paper Nursing Informatics Executive Leader. (2011).
http://www.aone.org/resources/informatics-executive-leader.pdf
• Definition of value proposition, (2019).
https://www.en.wikipedia.org/wiki/Value_proposition
• HIMSS Informatics-competencies (2010).
https://www.himss.org/informatics-competencies
• Murphy, J. (2009). “The Best IT Project Is Not an IT Project” JHIM N
Winter. 23 (1), 6-8.
• TechnologyInformaticsGuidingEducationReform (TIGER), (2009).
www.himss.org/file/1308891/download?token=C12Qjpt6. Collaborating to
Integrate Evidence and Informatics into Nursing Practice and Education:
An Executive Summary.
• Weckman, H., Janzen, S., (2009). "The Critical Nature of Early Nursing
Involvement for Introducing New Technologies" OJIN: The Online Journal
of Issues in Nursing, Vol. 14, No. 2, Manuscript 2.
References:
